Odontogenic Keratocyst is frequently misdiagnosed for a Lateral Periodontal Cyst in premolar and anterior tooth-bearing areas

INTRODUCTION

Radiolucent lesions with gingival swelling found in the premolar and intercanine region can elicit a different clinical diagnosis than one confirmed by histologic findings. The purpose of the study is to identify and present the frequency of the unexpected microscopic diagnosis of Odontogenic Keratocyst (OKC) in a location preoperatively favoring a Lateral Periodontal Cyst (LPC) with similar clinical and radiographic appearance.

METHODS

A retrospective analysis of biopsies received from 2011 and 2019 was performed and the number of LPC and OKC cases were assessed. The alignment of clinical and radiographic diagnosis to histologic findings and anatomic location was analyzed and the number of OKC cases preoperatively misdiagnosed as LPCs was identified.

RESULTS

A total of 79257 biopsies were received. Of those, 184 were diagnosed as LPCs and 742 as OKCs. For all preoperatively diagnosed LPCs, the clinical and histological diagnosis aligned; however, 182 of 742 OKCs were submitted with a clinical misdiagnosis of LPCs. The location of these lesions with the unanticipated diagnosis overlapped with those for LPCs, specifically the maxillary and mandibular anterior and premolar regions.

CONCLUSION

Radiolucent lesions with gingival swelling in the premolar and intercanine region are frequently clinically and radiographically misdiagnosed. A biopsy should be considered in all cases to establish the correct pathologic diagnosis and treatment course.

Guidelines for the Biopsy of Oral Mucosal Lesions Using a Laser

Dental lasers are increasingly being used to harvest soft-tissue biopsies. Lasers generally offer numerous benefits compared with conventional treatment modalities of tissue collection, including providing less trauma, uncomplicated healing, and faster recovery. Also, common problems seen with other novel methods of sample collection are avoided with the use of dental lasers. However, because of a laser's thermal effects, incisional margins may not always be as sufficiently defined as necessary for histopathologic analysis. Deficiencies associated with the use of a dental laser to collect a proper sample are related mostly to either insufficient tissue for diagnosis or other tissue artifacts, specifically thermal artifacts. This article, therefore, is aimed at assisting clinicians in enhancing biopsy technique when using a laser.

A Guide to Yellow Oral Mucosal Entities: Etiology and Pathology

When faced with an uncertain clinical pathosis in the oral cavity, identifying the color of the mucosal lesion helps to narrow down a differential diagnosis. Although less common than red and white lesions, yellow lesions encompass a small group of distinct mucosal pathologic entities. Adipose tissue, lymphoid tissue, and sebaceous glands are naturally occurring yellow constituents of the oral cavity and become apparent with associated developmental or neoplastic lesions. Reactive and inflammatory lesions can create a yellow hue due to purulence, necrosis, and calcification. Some systemic diseases are known to deposit yellow bi-products such as amyloid or bilirubin into the oral mucosa of an affected person, and while not always yellow, unusual entities like verruciform xanthoma and granular cell tumor fall under the umbrella of yellow lesions given their occasional propensity to demonstration the color. This chapter aims to explore the unique group that is yellow lesions presenting in the oral mucosa.

Preclinical effectiveness of a novel pulp capping material

INTRODUCTION

The purpose of this study was to evaluate the direct pulp capping response to a novel resin-based calcium phosphate cement (RCPC).

METHODS

The RCPC was placed in contact with the exposed healthy pulps of dog teeth and in a follow-up study on the healthy or inflamed pulps of ferret teeth. The inflamed ferret teeth had reversible pulpitis induced with Salmonella typhimurium lipopolysaccharides. After direct pulp capping with RCPC or visible light-curing resin-modified calcium hydroxide material (VLCCH) as a control, the restorations were bonded using a composite resin. The pulp responses and dentin repair were evaluated histologically in dog teeth after 7, 28, or 90 days and in ferret teeth after 45 days.

RESULTS

Most of the RCPC-treated healthy pulps and 75% of the RCPC-treated inflamed ferret teeth had dentin healing and repair, whereas those teeth treated with VLCCH had minimal healing and dentin repair.

CONCLUSIONS

The direct pulp capping of ferret and dog teeth with RCPC was associated with superior healing in comparison to VLCCH.

Multiple malignant salivary gland neoplasms: mucoepidermoid carcinoma of palate and adenoid cystic carcinoma of floor of mouth

Salivary gland tumors usually occur as single lesions. To have more than one tumor is unusual. We report a case of an adult male who presented with a mucoepidermoid carcinoma involving the minor salivary glands of the palate at age 57 years, followed by an adenoid cystic carcinoma of the floor of mouth at age 63 years. The patient later succumbed to non-Hodgkin lymphoma at age 72 years. There are 31 acceptable cases of multiple malignant salivary gland neoplasms reported in the world literature. Multiple malignant tumors of the same histologic type are more common than those of different histologic type. Bilateral acinic cell adenocarcinoma was the most frequent combination of multiple salivary gland malignancy, accounting for 14 cases (10 synchronous and four metachronous). All involved the parotid glands bilaterally with the exception of one case that involved parotid and submandibular gland. Polymorphous low-grade adenocarcinoma accounted for three of the four cases of multiple malignant tumors involving minor salivary glands. Individuals with a history of malignancy are at risk for the development of additional malignant tumors and should receive appropriate clinical follow-up.

The osteoinductive potential of demineralized freeze-dried bone allograft in human non-orthotopic sites: a pilot study

BACKGROUND

The use of demineralized freeze-dried bone allograft (DFDBA) in periodontal therapy is widely accepted. In addition to histologic studies demonstrating its role in regenerating the attachment apparatus, its recognized ability to exhibit osteoinduction in small laboratory mammals has prompted many clinicians to regard it as osteoinductive when utilized in periodontal therapy. Despite such a theoretical deduction, evaluating and establishing the osteoinductive potential of DFDBA in humans has been problematic. The purpose of this study was to investigate, through the use of a novel implantation/recovery model, the potential of DFDBA to induce new bone formation at sites not normally considered capable of de novo osteogenic activity.

METHODS

Seven patients scheduled to undergo periodontal therapy utilizing non-absorbable membranes agreed to have sterile polypropylene mesh capsules placed adjacent to the primary surgical site for the purpose of this investigation. One capsule was left empty while the second capsule contained DFDBA. At the appropriate time interval for removal of the therapeutic membrane, the capsules were removed and submitted for histologic analysis. Five of the subjects had procedures directed at regenerating bone within molar furcations (guided tissue regeneration) and had the membranes and associated capsules removed between 6 and 8 weeks. The 2 remaining patients had procedures directed toward ridge augmentation (guided bone regeneration) and had the membranes removed either at 8 or 9 months, respectively. In addition, one of the 2 long-term membrane patients had liberal cortical penetration performed directly beneath the implanted capsule.

RESULTS

Histologic analysis of all recovered capsules by 2 independent oral and maxillofacial pathologists could not confirm the presence of either osteoblastic or osteoclastic activity associated with the DFDBA particles, although the 2 longer-term specimens clearly exhibited trace amounts of vital bone non-contiguous with the implanted material.

CONCLUSIONS

The results of this pilot study do not support the osteoinductive potential of DFDBA when utilized in quantities normally associated with periodontal bone grafting, although they do support the use of this implantation/recovery model to study other preparations and mechanisms of bone formation.

Primary ameloblastoma of the sinonasal tract: a clinicopathologic study of 24 cases

BACKGROUND

Ameloblastomas are locally aggressive jaw tumors with a high propensity for recurrence and are believed to arise from the remnants of odontogenic epithelium. Extragnathic ameloblastomas are unusual and primary sinonasal tract origin is extraordinarily uncommon.

METHODS

Twenty-four cases of ameloblastoma confined to the sinonasal tract were retrieved from the Otorhinolaryngic-Head & Neck Pathology and Oral-Maxillofacial Pathology Tumor Registries of the Armed Forces Institute of Pathology between 1956 and 1996.

RESULTS

The patients included 5 females and 19 males with an age range of 43-81 years, with a mean age at presentation of 59.7 years. The patients presented with an enlarging mass in the maxillary sinus or nasal cavity (n = 24), sinusitis (n = 9), or epistaxis (n = 8). Unilateral opacification of the maxillary sinus (n = 12) was the most common radiographic finding. Histologically, the tumors exhibited the characteristic features of ameloblastoma, including peripherally palisaded columnar cells with reverse polarity. The majority of the tumors showed a plexiform growth pattern. Fifteen tumors demonstrated surface epithelial derivation. Surgical excision is the treatment of choice, ranging from conservative surgery (polypectomy) to more aggressive surgery (radical maxillectomy). Five patients experienced at least 1 recurrence, usually within 1 year of initial surgery. With follow-up intervals of up to 44 years (mean, 9.5 years), all 24 patients were alive without evidence of disease or had died of unrelated causes, without evidence of disease.

CONCLUSIONS

Primary ameloblastoma of the sinonasal tract is rare. In contrast to their gnathic counterparts, sinonasal tract tumors have a predilection for older age men. Therapy should be directed toward complete surgical resection to prevent local tumor recurrence.